How does ICSI work?
Although ICSI has been around since the early 1990s, it’s increasingly being used nowadays to help couples struggling with infertility. ICSI (intracytoplasmic sperm injection) is a specialized procedure of in vitro fertilization that is used mostly commonly in cases of severe male infertility, after failed fertilization attempts with conventional IVF, or after egg freezing (oocyte preservation). ICSI involves injecting a single sperm directly into an egg using a fine glass needle (on contrary to standard IVF where the sperm has to penetrate the egg by itself). The procedure was developed in 1992 and according to the American Society for Reproductive Medicine (ASRM), 60 to 80 percent of eggs are fertilized using ICSI.
Why is ICSI Done?
ICSI is typically used in cases of male infertility, including:
- Oligospermia, sometimes called oligozoospermia (Very low sperm count)
- Teratozoospermia(semen alteration in which there is a large number of spermatozoa with abnormal morphology)
- Asthenozoospermia(Poor sperm motility)
Testicular sperm extraction(TESE) is a surgical sperm retrieval procedure used in fertility treatment for men who have no sperm in their ejaculate (when there is a blockage in the route between the testes and ejaculation or because there is a partial or complete failure in sperm production in the testes). Nevertheless, the numbers of sperm that retrieved is often very low, it is necessary to combine TESE with ICSI.
ICSI is also used in cases of retrograde ejaculation (entry of semen into the bladder instead of going out through the urethra during ejaculation). ICSI can also help men who were born without a vas deferens or who had a vasectomy.
The male infertility isn’t the only reason ICSI is used. Other evidence-based reasons for the usage of ICSI include:
- Frozen sperm are being used: ICSI-IVF may be recommended when the thawed sperm don’t appear especially active
- Earlier IVF cycles having few or no fertilized eggs: ICSI may be tried in the case when a good number of eggs are retrieved, and sperm counts look healthy, but no eggs get fertilized.
- Frozen oocytes are being used: sometimes, vitrification of eggs can cause hardening of the egg’s shell which may complicate fertilization, and IVF with ICSI may help overcome this problem.
- IVM (in vitro maturation) is being used: IVM is an IVF technology where eggs are retrieved from the ovaries before they completely mature with hormonal injections. They go through the final stages of maturation in the lab culture using hormones or a naturally occurring oocyte protein dimer. More research is still going on, but it may be that IVM with ICSI is a good option.
- PGD is being done: PGD (preimplantation genetic diagnosis) is an IVF technology testing of pre-implantation stage embryos or oocytes for genetic defects. ICSI is used commonly during PGD to remove the risk of contamination from extraneous sperm DNA.
What Is the Procedure for ICSI?
ICSI is done as a part of IVF. Since ICSI is done in the lab, this won’t seem much different than an IVF treatment without ICSI.
There are five main steps to the ICSI procedure:
- You’ll take ovarian stimulating drugs (just like the regular IVF) and your doctor will monitor your progress with blood tests and ultrasounds. You’ll have the egg retrieval after you’ve grown enough good-sized follicles. The eggs are removed from your ovaries with a specialized, ultrasound-guided needle.
- A sperm sample is taken from your partner’s semen or surgically extracted from his testes or epididymis on that same day (unless you’re using a previously frozen sperm or a donor sperm). There appears to be no difference in pregnancy rates between those who use frozen or fresh sperm during the ICSI process.
- The embryologist will place the eggs in a special culture and ICSI procedure is performed by using a technique called micromanipulation. Using a microscope and tiny, hollow needle, a single sperm will be injected directly into an egg. This will be done for each egg retrieved.
- Once the fertilization takes place and normal growth is observed, the healthy embryos will be implanted into your uterus, via a catheter placed through the cervix, two to five days after the retrieval.
Thanks to the wonders of assisted reproductive technology (ART), doctors and scientists have made such astonishing breakthroughs with several fertility treatments. There are ICSI techniques currently under clinical development that may be we will be able to inspect and scrutinize sperm even more effectively so the best sperm can be selected. It is amazing that now we also have the ability to fertilize an egg with just one sperm, preventing the heartbreak and offer hope to many couples who wish to have their own biological children.
Mathrutva Fertility Centre is a well-known infertility hospital India with a national and international recognition for infertility-related treatments and IVF services. They have now infertility treatment services’ covering four states, ICSI treatment Bangalore is offered in Koramangala and Malleswaram. The fertility hospitals are among the first few comprehensive dedicated infertility hospitals in South Asia.
The primary objective of the infertility centres is to offer high success rates with low cost IVF infertility treatments under one roof. They offer over 10 years of experience, expertise and cutting edge reproductive technologies designed for individual needs.